If we could call it upcoding, it would be an understatement to call it upcoding to infinity.
Tag: compliance
Fraud on Fridays: Fraud on Physicians in the ASC Setting
When you think about fraud at an ASC, you tend to think about fraud on payers, from Medicare to well, Blue Cross. You know, cases that never happened, patients who didn’t suffer from any medical issue, and the like. But what about fraud on physicians at an ASC? Because physicians hardly think about it, it…
Fraud on Fridays: $10.6 Billion – Does Crime Pay?
In a healthcare billing and payment system that’s so complex, it’s sad to say that criminals can stay a few steps ahead of the Feds. With $10.6 billion in bogus billing, some cutouts got caught, but the masterminds appear to have escaped with close to $1 billion.
How to Use the Law Before it Uses You.
Some laws derive from morality and others are purely the result of politicking and protectionism.
$500 Million in Alleged Phony Charges and the Dangers of Medical Directorship
A $500M medical directorship fraud case exposes how physicians can be exploited. Protect your practice from legal and financial fallout.
Leasing Out Your Medical License? From a Few Bucks to a Felony
As physicians get squeezed by insurers and other payers, including Medicare, and as the costs of operating a medical practice increase, more are looking for ways to supplement their income.
A Ban on PE in Medical Practice and a Gutting of Practice Value
Certainly, Oregon is a small state in terms of medical practice, but what’s happened in Oregon could, and some say will, spread across the country.
Pain Doc Likely in Pain After Settling Allegations That Billed Procedures Weren’t Performed
Was it a scam or an error? A settlement is just that and there’s been no determination of liability.
Neither you nor I can know for sure what went on, but either way, there’s a lesson here about billing compliance.
14 Month Prison Term in “Doctor Chasing” Scam
There’s huge danger in any arrangement in which you put your prescribing imprimatur on any script or order for any item, especially those reimbursed by Medicare.
DOJ to Focus on Criminal Healthcare Fraud and Prosecuting the Individuals Involved
In real life healthcare compliance, there’s no get out of jail free card.